{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mona Gagnon","gend":1,"currentgend":"","add":"6 GILLMAN ST","city":"Waterville","state":"ME","zip":"04901","dob":"1963-01-09","age":"","mstatus":"","insh":"10000017545","cliId":"","pno":"2076923034","cno":"2076494999","email":"declined@070723.com","ename":"","eno":"","pphy":"PHELPS, JULIE J","ppno":"","pcpadd":"Waterville Family Practice,31 Front St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"6 GILLMAN ST","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":"2078731186","pcpnpi":"1679562979","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PG3XR4EG00","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H04203","M0600","Z5181","Z7969","H01119","G43709","Z79899","H60503","H6123","H906","Z974","J0180","Z20822","R059","F319","I999","F819","F0670","M5417","M064","M25511","M25512","M790","M4727","M4856XA","M5116","M5117","H903","M47817","E039","M8580","E785","Z0000","Z23","Z1331","Z139","M75102","F4310","M75122","M75101","M75121","H6093","G4733","N3946","Z1231","M810","Z780","M85859","U071","M5450","S46811A","M7521","S46811D","Z5189","E559","H6122","H6092","M79642","Z111","M79641","M7501","M19011","M19012","J0190","Z87891","R051","Z0101","Z961","H524","H5203","H52223","M0609","S46812D","X58XXXD","H538","Z79620","M67813","J209","M25811","Z4889","R600","R0602","H8112","N3941","I69954","G8929","R4182","E669","Z6835","I360","I517","H02844","H02845","Z1211","H0289","M5410","H019","M7989","Z98890","Z0189","D122","Z9621","I2720","R062","Z4789","J40","H9201","H6121","E8342","G4700","Z45321","G4730","R92313","I639","G8194","K219","I10","F3131","G43909","M48061","R609","M549","Z1389","I309","G894","J189","H9193","E876","R7989","R509","Z0389","Z86010","J101","H40013","S01311A","M65822","R300","R42","R197","Z1152","R410","R000","J069","R918","I499","R5381","Z09","Z860101","M7581","M79604","Z13820","R591","D72819","M85832","K635","K644","F445","H6502","H6063","H6690"],"date":["2023-04-12","2026-02-11","2025-03-24","2023-04-11","2023-05-01","2025-04-23","2026-01-13","2023-05-02","2025-06-11","2023-05-02","2023-05-02","2023-12-18","2023-05-12","2025-02-18","2026-02-05","2023-12-21","2023-06-23","2026-02-05","2023-06-29","2025-03-13","2024-09-03","2024-11-06","2023-07-25","2023-08-04","2023-08-04","2025-10-09","2023-08-04","2025-11-10","2025-09-03","2025-10-06","2024-09-18","2025-10-06","2025-10-21","2025-09-27","2025-10-06","2025-10-06","2024-04-15","2025-06-05","2023-09-29","2024-05-30","2023-11-28","2023-10-10","2026-02-20","2023-10-09","2026-01-27","2025-03-13","2025-12-08","2025-12-08","2023-11-02","2025-08-12","2023-10-02","2024-04-02","2023-10-04","2023-11-15","2025-10-06","2023-12-18","2024-04-03","2023-12-13","2023-12-13","2023-12-13","2024-01-02","2024-04-18","2024-03-06","2024-03-15","2025-11-07","2024-03-25","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2024-02-15","2024-02-05","2024-02-05","2025-12-09","2024-04-16","2024-04-18","2025-09-22","2024-05-30","2024-07-12","2025-10-27","2025-03-19","2025-12-24","2026-01-13","2026-01-13","2026-02-18","2025-01-31","2025-06-06","2024-11-07","2025-10-27","2025-10-27","2026-02-04","2026-02-04","2024-08-13","2026-03-05","2026-02-20","2026-02-20","2025-05-20","2025-03-31","2025-05-29","2024-08-13","2025-10-08","2025-03-13","2025-03-19","2024-11-25","2025-04-02","2025-06-18","2025-06-18","2024-08-05","2026-02-05","2025-11-10","2026-01-16","2026-01-27","2025-11-07","2025-11-07","2025-07-01","2025-07-01","2025-01-16","2026-01-05","2025-10-09","2024-07-10","2024-12-11","2025-10-06","2026-02-04","2025-11-11","2025-03-11","2024-12-13","2025-03-26","2025-02-18","2025-02-18","2025-03-11","2024-08-13","2025-04-02","2025-12-09","2025-08-12","2024-10-15","2025-12-23","2026-01-02","2025-02-03","2025-02-17","2026-01-02","2025-02-18","2025-11-20","2025-02-18","2026-01-02","2026-01-02","2025-04-30","2025-04-30","2024-10-15","2025-05-16","2025-12-08","2025-04-02","2025-03-26","2025-12-08","2024-08-13","2024-08-13","2023-02-15","2023-01-17","2023-01-17","2023-01-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","LEFLUNOMIDE","20 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","ALENDRONATE","10 MG","","Select","Select",""],["","","SOLIFENACIN","10 MG","","Select","Select",""],["","","Bd Nano 2 Gen","","","Select","Select",""],["","","OLANZAPINE","10 MG","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","TERIPARATIDE","20 MCG\/DOSE","","Select","Select",""],["","","CLONAZEPAM","1 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Miebo","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","DIPHENOX\/ATROPINE","2.5\/0.025 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","LEVOTHYROXINE","125 MCG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","DULOXETINE","30 MG","","Select","Select",""],["","","HYDROXYCHLOROQUINE","200 MG","","Select","Select",""],["","","RIZATRIPTAN","5 MG","","Select","Select",""],["","","TOPIRAMATE","100 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","MECLIZINE","25 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","CEFUROXIME","500 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","MONTELUKAST","10 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","TROSPIUM","20 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","HUMIRA PEN","","","Select","Select",""],["","","CAREONE UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","Triamcinolone Acet 0.025 % Lotion Quagen","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","PROMETHAZINE","25 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Tizanidine","2 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp Dr","","","Select","Select",""],["","","RINVOQ","","","Select","Select",""],["","","VEOZAH","","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","Neo\/Polymyx\/Hydrocortisone 3.5\/10","","","Select","Select",""],["","","PEG","3350\/ELECTROLYTES 420","","Select","Select",""],["","","BD NANO","","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","NEO\/POLYMYX\/HYDROCORTISONE","","","Select","Select",""],["","","CIPROFLOX\/DEXAMETH","0.3\/0.1 %","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}